A dozen individuals, seated around folding tables, erupt in applause for a jubilant woman who has just donated two 13-gallon garbage bags full of clothes—Christmas sweaters, pantsuits, and more—to a local Presbyterian church.
For most, a closet cleanout might not seem like a significant achievement, but for those struggling with hoarding disorder, it is a monumental step forward.
Hoarding disorder is characterized by the excessive accumulation of items—whether it’s household goods, craft supplies, or even pets. In extreme cases, homes become so overcrowded that navigating from one room to another is only possible through narrow pathways.
Beyond the physical clutter, hoarding leads to emotional and relational strain. Bernadette, a woman in her early 70s from Pennsylvania, describes how the disorder has led to strained relationships. Since retiring, she stopped allowing guests in her home, overwhelmed by the embarrassment and shame her hoarding caused. She adds, “I’ve had a few relatives and friends that have condemned me, and it doesn’t help.”
People with hoarding disorder are often unfairly stigmatized, labeled as lazy or dirty. To protect the identities of those involved, NPR, Spotlight PA, and KFF Health News have chosen to use only the first names of individuals interviewed for this article, as they fear potential personal or professional repercussions if their condition were made public.
As the baby boomer generation ages into the demographic most affected by hoarding disorder, the condition is becoming a significant public health issue. Despite the rising prevalence, effective treatments remain scarce, and interventions are often costly, draining municipal resources. More funding and expertise are urgently needed to assist those affected before the situation escalates into a crisis.
For Bernadette, a 16-week course offered by Fight the Blight has been transformative. The program, which doubles as a support group, is provided by the Westmoreland County, Pennsylvania, nonprofit, which began offering the course at a local Masonic temple. The founder, Matt Williams, recognized that the area lacked mental health services that specifically addressed hoarding disorder.
The program utilizes a curriculum based on cognitive-behavioral therapy, guiding participants to recognize what fuels their hoarding tendencies. Individuals learn how to be more deliberate with their purchases and possessions, and they create strategies to manage the overwhelming process of decluttering.
Perhaps most importantly, the group offers an opportunity for individuals to build connections with others who understand their unique struggles. “You get friendship,” says Sanford, another class member, reflecting on the camaraderie he has found.
For many participants, the friendships forged in the group have become an essential part of their journey toward clearing out the clutter. These connections provide support in an area of mental health often marked by isolation and shame.
Studies estimate that hoarding disorder affects around 2.5% of the general population, a higher rate than schizophrenia. Although it was once considered a subtype of obsessive-compulsive disorder, hoarding disorder was formally recognized as a distinct diagnosis in 2013 in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
The reasons behind hoarding are not fully understood, as both biological and environmental factors may contribute. However, hoarding symptoms typically emerge during adolescence and tend to become more severe in older adults. This is partly due to the time accumulated to gather possessions, says Kiara Timpano, a psychology professor at the University of Miami. “All of a sudden you have to downsize this huge home with all the stuff, and so it puts pressure on individuals,” she explains.
For older adults, the urge to accumulate may strengthen over time, a trend that has not been fully understood. According to Catherine Ayers, a psychiatry professor at the University of California-San Diego, cognitive changes associated with aging—particularly in the frontal lobe, which governs impulsivity and problem-solving—could worsen hoarding tendencies.
“It is the only mental health disorder, besides dementia, that increases in prevalence and severity with age,” Ayers notes.
As the U.S. population ages, hoarding disorder presents an increasing public health challenge. Baby boomers—who make up about 20% of the population—will all be 65 or older by 2030, and this demographic shift will require the government to address hoarding disorder and other age-related issues that have long been underfunded and under-researched.
The physical risks posed by hoarding are significant. A cluttered, disorganized home can be particularly hazardous for older adults due to the increased risk of falls. Excessive possessions can also present fire hazards. The National Fallen Firefighters Foundation recently expressed concerns to the U.S. Senate, warning that hoarding conditions are among the most dangerous situations encountered by firefighters. The cluttered environment can delay emergency response and increase the likelihood of injuries for first responders.
Additionally, the Bucks County Board of Commissioners in Pennsylvania pointed out that hoarding-related mold and insects could spread to neighboring homes, potentially jeopardizing the health of others.
Given these serious safety concerns, family members or public health agencies may be tempted to quickly clear out a hoarder’s home. However, experts like Timpano warn that such drastic action can have adverse consequences, as it doesn’t address the root psychological issues and can damage trust, making future help less likely.
Instead, the focus should be on helping individuals build internal motivation for change and setting small, manageable goals to address their hoarding, which is more likely to be successful in the long term.
For example, at Fight the Blight’s class, one woman named Diane shared her goal of cleaning her home to the point where she could invite guests over without feeling embarrassed. Sanford is working on organizing his documents and record collection. Bernadette hopes to declutter her bedroom so she can start sleeping there again and make room for her cat to play.
Ultimately, Timpano stresses that the goal of treatment is not to achieve a perfectly tidy home, but to create a safe and healthy living space. “It’s OK if a home is still a little cluttered,” she says. “The goal is to make it a safe and functional space for the individual.”
Hoarding disorder is notoriously difficult to treat. A 2020 study found that hoarding correlates with homelessness, and those with the condition are more likely to face eviction. Advocates argue that under the Fair Housing Act, tenants with hoarding disorder should be granted reasonable accommodations, such as extra time to declutter before being forced to leave their homes. However, a lack of resources limits the ability to implement these accommodations effectively.
Hoarding disorder presents unique challenges, as it requires patients to remain motivated and receive substantial ongoing support to succeed in therapy. A shortage of clinicians with expertise in treating hoarding exacerbates this problem, according to Janet Spinelli, co-chair of Rhode Island’s hoarding task force.
Former U.S. Senator Bob Casey (D-Pa.) has advocated for greater support for hoarding disorder, including more education and technical assistance for both communities and clinicians. In 2022, he called for the Substance Abuse and Mental Health Services Administration (SAMHSA) to develop training and guidance for professionals dealing with hoarding disorder. He also pushed for the Centers for Medicare & Medicaid Services (CMS) to explore ways to fund treatments and services for hoarding.
One proposed solution is to increase Medicare funding for mobile crisis services, which can connect individuals with therapists in their homes. Additionally, allowing Medicaid and Medicare to reimburse for community health workers to assist with light cleaning and organizing could be helpful, as many hoarders struggle with categorizing items.
Williams, from Fight the Blight, agrees that more mental health support is necessary, as well as taxpayer-funded services to help people address the physical clutter in their homes. When participants reach a point where they are ready to declutter, Fight the Blight helps with the cleanup process, offering free assistance for those earning less than 150% of the federal poverty level, and charging a sliding scale fee for those who earn more.
Spinelli also believes that more peer-support specialists—who draw from their own experiences—could be beneficial in helping individuals with hoarding disorder. Peer counselors could lead groups similar to the Fight the Blight classes.
Both Bernadette and Sanford believe that support groups like the one they are part of should be available across the U.S. They advise those beginning to confront their hoarding disorder to be patient and persistent, as even small efforts can accumulate over time. “Even if it’s a little job here, a little job there,” Sanford says, “that all adds up.”
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